60 and identified them with one option or the other. The courtroom dispute also gave a distorted picture of psychiatry, since doctors agree on psychiatric diagnoses in eighty per cent of their cases. The challenge of diagnosing Hinckley's mental condition at an instant in history and using that con- clusion as a basis for judging his crimina] responsibility was essentially a legal one. Doctors who regularly take such challenges are called foren- sic psychiatrists, and no matter how good they are as psychiatrists they often have reputations as hired guns. Out of thirty thousand American psy- chiatrists, fewer than a thousand are forensic psychiatrists, and only a hun- dred and twenty-five of these regular- ly testify on criminal responsibility. They and other psychiatrists recognize that it is a difficult task to diagnose and treat someone's mental condition in the present, without the added prob- lem of trying to explain his past be- havior on the basis of evidence that is often prejudiced and stale. In court, the doctors preferred to speak about mental disorder; the law- yers, using the terms of the insanity defense, referred to mental disease or defect. Whatever John Hinckley's mental illness was called, it did not guarantee that he would be found le- gally insane. The insanity law in the District of Columbia required, first, that psychiatrists find that he suffered from a mental abnormality and, sec- ond, that the jury find that as a result of the abnormality he could not tell right from wrong or abide by the law. The glossary for the doctors' debate was the third edition of the "Diagnos- tic and Statistical Manual of Mental Disorders," known informally as DSM-III The American Psychiatric Association pub- lished the first edition of this volume in 1952. As an introduction to the latest manual explains, the first and second editions did not provide "explicit criteria" for menta] disorders; doctors were on their own in defining the "contents and bounda- ries of the diagnostic categories" from clinical experience. The third edition, published after heated debate within the A.P .A., "provides specific diagnos- tic criteria as guides for making each diagnosis," and in field tests doctors have applied these criteria with between eighty and ninety per cent agreement for severe mental illnesses and between sixty and seventy per cent agreement for less severe disorders. The criteria o ,'- "\.' \ \ lead some lawyers and doctors to call DSM - III a cookbook, and the intro- duction to the latest manual offers sev- eral disclaimers, such as "In DSM - III there is no assumption that each men- tal disorder is a discrete entity with sharp boundaries (discontinuity) be- tween it and other menta] disorders, as well as between it and No Mental Disorder" and "A common miscon- ception is that a classification of men- tal disorders classifies individuals, when actually what are being classified are disorders that individuals have. F or this reason, the text of DSM - III avoids the use of such phrases as 'a schizophrenic' or 'an alcoholic,' and instead uses the more accurate, but admittedly more wordy, 'an individual with Schizophrenia' or 'an individual with Alcohol Dependence.'" One doctor, in an attempt to find a legal analogy, called DSM-III the statute law of psychiatry. Given the debate within the psychiatric profession about the book and its evolution, he might have called it psychiatry's common law, to be applied according to the experience, training, and idiosyncra- sies of each judge. John Hopper was the first doctor to take the stand. Angular and tanned, he wore aviator glasses and blinked slowly before answering the questions of lawyers for both sides. He spoke in a weary voice, as if to him the trial were a bad dream that he hoped to put to rest by explaining why he had treated John Hinckley as he did, from Octo- ber, 1980, through February, 1981. From the start, he had discounted the seriousness of Hinckley's illness. When the Hinckleys told Hopper of John's suicide attempt, the Doctor didn't ask to see him right away. In- stead, he telephoned John to ask if he had really tried to kill himself. Hopper's notes on the four months of treat- ment consisted of fourteen t.d pages, a few of them with only two or three lines of comments. Three pages dealt with the "severe marital discord" of Hinck- ley's parents. Where the notes listed "what's been tried," the items were entered from the perspective of the parents: "Being patient, abiding him, doctors, giving money." In Hopper's view, John was a "typical case" in Evergreen, frustrated by his inabil- ity to "get anywhere in writing" or to keep up with the rest of a successful family. According to Hopper, a plan ("setting some goals and objectives") and biofeedback ("the use of equip- JULY 2, 1984 ment which shows a person either vi- sually or auditorially in which direc- tion relaxation is going") were the proper treatment for Hinckley's de- pression and anxiety. After twenty- two sessions with John Hinckley, the Doctor knew nothing of Hinckley's trips to Hollywood, his extreme inter- est in "Taxi Driver," his reading, his fail ure to enroll in any program at Yale when he went to New Haven to meet Jodie Foster, his trip to Dayton, his arrest in Nashville, his target prac- tice, his travels around the country, or his plan to kill the President. Because of Hopper's role as the defendant's onetime therapist, John Hinckley's lawyers could not afford to ridicule the Doctor. But they presented him as a witness of fact and not as a medical expert. They tried to use Hopper's failure to recognize John's symptoms as evidence of a deceptive illness: Hinckley had fooled even a trained psychiatrist. At the end of his testi- mony, Hopper asked to talk with the Judge. The Judge called the lawyers to the bench. "I don't have the slight- est idea what this man is going to say and I don't want to hear him," he declared. A lawyer for the defense said, "I think he may be concerned because there is the impression in the jury's mind right now that he did not believe that John Hinckley was suffer- ing from a mental illness. . . . There is something still bothering the man." The Judge responded, "Well, there is somethIng bothers everybody in this case." While court was in session, the Judge would not hear another word out of Hopper. The first expert for the defense was William Carpenter, a psychiatrist who studies and treats schizophrenia at the University of Maryland. A tall man with a silvery beard and shoulder- length hair, he resembled Father Time. Folded into the witness stand, he spoke in a smoky drawl, and his meandering answers tested the pa- tience of the Judge. "I need to keep the dates straight to look at it here because there are so many different places he has gone over the next few days," said Dr. Carpenter, referring to Hinckley's travels in the month before the shooting. "But he left Denver on February the ninth, flew to New York, and went to New Haven. The next day, the tenth, he went to Wash- ington, D.C., and the next day back to N ew York, and over the next few days he is going back and forth from New York to New Haven. On the six- teenth, he comes back to Washington.